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J Nephropathol. 2021;10(4): e45.
doi: 10.34172/jnp.2021.45
  Abstract View: 153
  PDF Download: 77

Case Report

The coexistence of membranous glomerulonephritis and its cause in the same biopsy: the two faces of IgG4-related kidney disease

Francesco Fortarezza 1 * ORCID logo, Michele Rossini 2 ORCID logo, Maria Grazia Fiore 1 ORCID logo, Domenico Piscitelli 1 ORCID logo, Loreto Gesualdo 2, Leonardo Resta 1 ORCID logo, Roberta Rossi 1 ORCID logo

1 Department of Emergency and Organ Transplantation, Pathology Division, Medical School, University of Bari, Bari, Italy
2 Department of Emergency and Organ Transplantation, Nephrology Division, Medical School, University of Bari, Bari, Italy
*Corresponding author: Francesco Fortarezza, Email: francescofortarezza.md@gmail.com

Abstract

IgG4-related disease (IgG4-RD) is a systemic immune-mediated disease characterized by fibroinflammatory tumor-like masses that show the peculiar morphological features of storiform fibrosis, lymphoplasmacytic infiltrates rich in IgG4 positive plasma cells and obliterans phlebitis. The disease affects virtually any organ or apparatus and is often associated with increased serum IgG4 levels. Many previously described conditions (e.g. autoimmune pancreatitis, Mikulicz’s syndrome, Küttner’s tumor, and Riedel’s thyroiditis) are now classified to be part of IgG4-RD with the characteristic clinic, serologic and pathologic features. The kidney represents an important target-organ of the disease, mainly as tubulointerstitial nephritis (TIN). Nevertheless, some cases of glomerular disease, especially membranous glomerulonephritis (MNG), have been described in IgG4-related TIN. We report a case of IgG4-related kidney disease in which the two pathological patterns, TIN and MNG, were observed simultaneously in the same biopsy.
Keywords: IgG4-related kidney disease, Tubulointerstitial nephritis, Membranous glomerulonephritis, Kidney biopsy

Implication for health policy/practice/research/medical education: The membranous glomerulonephritis is one of the clinicopathological manifestations of the IgG4-related kidney disease.

Please cite this paper as: Fortarezza F, Rossini M, Grazia Fiore M, Piscitelli D, Gesualdo L, Resta L, et al. The coexistence of membranous glomerulonephritis and its cause in the same biopsy: the two faces of IgG4-related kidney disease. J Nephropathol. 2021;10(4):e45. DOI: 10.34172/jnp.2021.45.

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Submitted: 11 Jan 2020
Accepted: 23 Mar 2020
ePublished: 14 Apr 2020
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